Slow Flow/No-Reflow After Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: A Meta-Analysis.
Jian Cheng, Qiangsong Jin, Biao Tang
✦ AI-curated · Sources linked
In 30 seconds
This meta-analysis synthesized clinical, laboratory, angiographic, and procedural factors associated with coronary slow flow/no-reflow after primary PCI for STEMI. It included 43 observational studies and 27,405 patients, of whom 5,631 had slow flow/no-reflow. Crude pooled analyses supported associations with factors including diabetes, higher Killip class, impaired baseline TIMI flow, high thrombus burden, and longer stent length; adjusted-only analyses were consistent for age, hypertension, diabetes, higher Killip class, and high thrombus burden. Overall certainty was low or very low, so the findings map associations rather than establish causes or provide a prediction score.
Key findings
- Across 43 observational studies, 5,631 of 27,405 patients had slow flow/no-reflow after primary PCI.
- Crude pooled analyses supported associations with diabetes, Killip class II or higher/acute heart failure, impaired baseline TIMI flow, and high thrombus burden.
- Adjusted-only analyses were consistent for age, hypertension, diabetes, Killip class II or higher/acute heart failure, and high thrombus burden.
- Risk-of-bias judgments were predominantly some concerns or high concern, and evidence certainty was low or very low.
Why it matters
Slow flow/no-reflow limits myocardial reperfusion after primary PCI. This synthesis brings together potential clinical, angiographic, and procedural correlates, helping frame which factors merit attention in research and interpretation of the evidence. However, uncertainty across studies means the associations should not be treated as causal explanations or as a validated bedside prediction tool.
What to keep in mind
The evidence came from observational studies, with predominantly some concerns or high concern for risk of bias and low or very low certainty. Several prediction intervals included the null, and sensitivity analyses did not remove important uncertainty.